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Schoolchildren Who Add Hand Sanitizer To Washing Still Get Sick

NPR Health Blog - Wed, 08/13/2014 - 12:36pm
Schoolchildren Who Add Hand Sanitizer To Washing Still Get Sick August 13, 201412:36 PM ET

If a kid is already washing his hands well, adding sanitizer in school doesn't appear to help reduce illnesses and absences.

Juanmonino/iStockphoto

Schools can be a great breeding ground for colds, stomach viruses, the flu and other bugs kids (and their parents) would rather not get.

Researchers wanted to know whether the transmission of those baddies could be reduced by telling elementary school children to use hand sanitizer in addition to the usual hand washing. But their study, conducted in 68 primary schools in New Zealand, found putting sanitizer in classrooms might not be worth the money and effort in higher-income countries, where soap and clean water are readily available.

Half the schools were randomly assigned to get the sanitizer. In those schools, the kids had a 30-minute educational session on hand hygiene and were also told to use the hand sanitizer dispensers after coughing or sneezing and when they left the classroom for recess or lunch. (The active ingredient in the hand sanitizer was plain old alcohol, not the antibacterial triclosan, which is controversial for its potential to create antibiotic-resistant bacteria.) Kids in the other schools just got the session on hand hygiene.

After the 20-week study was over, the researchers followed up with caregivers of a randomly selected sample of 2,443 students. The absence rates due to illness in the sanitizer and nonsanitizer groups were similar. Nor was there a difference in absence rates due to a specific illness, say, a gastrointestinal bug. And the family members of those kids in the soap-only group didn't get sick more often either.

The study was conducted in 2009 and began right before the H1N1 flu pandemic began. So the researchers cautioned that kids might have been more careful about hand hygiene in general, thanks to public health efforts aimed at curtailing the spread of the flu. Still, they conclude that this study and others conducted in high-income countries "show that the addition of hand sanitizer to existing hand hygiene facilities does not result in important benefits."

But Dr. Aaron Glatt, executive vice president at Mercy Medical Center in Rockville Centre, N.Y., and a spokesman for the Infectious Diseases Society of America, emphasizes that this doesn't mean there's any harm in using alcohol-based hand sanitizers in schools. It's only that they don't seem to help much there. (Of course, this research can't say anything about the effectiveness of sanitizers in other settings, like the hospital.)

But Glatt notes that schools, like the workplace or other places where people gather together in close proximity, are "absolutely" sites of disease transmission. So whether or not a kid uses sanitizer, basic hand hygiene is essential to cutting back on those sick days.

The findings appear in PLoS Medicine.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Many Big Employers Plan To Offer Skimpy Health Options Despite Law

NPR Health Blog - Wed, 08/13/2014 - 11:23am
Many Big Employers Plan To Offer Skimpy Health Options Despite Law August 13, 201411:23 AM ET

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Quite a few big businesses plan to offer workers health insurance options that have so few benefits that they don't comply with the Affordable Care Act.

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Nearly 1 in 6 companies plans to offer health coverage that doesn't meet the Affordable Care Act's requirements for value and affordability, a national survey of employers finds.

Many thought such skimpy coverage would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 these so-called skinny plans along with at least one insurance option that does qualify under ACA standards.

The results weren't entirely unexpected. Last year, it became clear that ACA regulations would allow skinny plans and even make them attractive for some employers. But this survey gives one of the first looks at how many companies followed through.

"It is a little higher than I would have expected but does not surprise me," says Timothy Jost, a law professor who specializes in consumer health at Washington and Lee University in Virginia. "It would be interesting to know what sectors of the economy these employers are in." Low-benefit plans traditionally have been offered by hotels, restaurant chains and other lower-wage industries, Jost said, "but this may be spreading."

The survey compiled responses from 136 large employers but didn't specify which industries made up the 16 percent offering low-benefit plans.

"My guess is that they are probably in those industries with low-wage employees where they have historically not been attracted to taking a lot of their paycheck for coverage and wanted something smaller," said Steve Wojcik, vice president of public policy at the National Business Group on Health.

Skinny plans are part of a two-step strategy that lets workers and employers avoid health law penalties but may not produce substantial coverage. Some skinny plans cover preventive care and nothing else — no inpatient or outpatient hospital treatment, says Edward Fensholt, a benefits lawyer with Lockton Cos., a large insurance brokerage and consulting firm.

It works like this. Employers can shield themselves from health law penalties by offering insurance that meets tests for affordability and value — regardless of whether anybody signs up. At the same time, workers can avoid the ACA's individual penalty by enrolling in a company skinny plan, which qualifies as "minimal essential coverage" for individuals under the health law by the mere fact that it's employer-sponsored.

In practice, employees in low-pay industries often decide that the substantial plan is too expensive even though it meets ACA standards, Fensholt said. (The ACA says coverage is affordable if the employee's contribution is 9.5 percent of household income or less.)

So workers sign up for the skinny plans, which shield them from the individual mandate penalty (the greater of $95 or 1 percent of their income) but offer little coverage.

"Employees need to know that if they choose one of these plans, it may be cheap and may satisfy the individual mandate requirement, but it may offer little protection if they actually get sick," said Jost.

Even so, at Las Vegas hotels and elsewhere, employees are asking for skinny plans and employers are offering them to stay competitive, Fensholt said.

"Some of these employers are doing it because their competitors are doing it," he said. "They don't want to lose these employees."

Potentially large medical bills aren't the only disadvantage for workers at companies using the two-step strategy. By offering an ACA-compliant plan, their employers disqualify them from getting subsidized insurance through HealthCare.gov or other online exchanges — even if they don't sign up for the company policy.

The survey also showed a continued move by large companies toward high-deductible, "consumer-directed" health plans and tools for workers to shop around for care. Consumer-directed plans, often paired with a tax-favored health savings account, feature deductibles of thousands of dollars. Deductibles are what consumers pay for care before the insurance kicks in.

Next year, 32 percent of companies surveyed intend to offer a consumer-directed plan and nothing else — "larger than I would have expected," said Karen Marlo, a vice president at National Business Group on Health. "We were really surprised at how much the survey over and over again pointed the finger at consumerism."

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Biologists Choose Sides In Safety Debate Over Lab-Made Pathogens

NPR Health Blog - Wed, 08/13/2014 - 3:25am
Biologists Choose Sides In Safety Debate Over Lab-Made Pathogens August 13, 2014 3:25 AM ET Listen to the Story 7 min 48 sec  

An outbreak of bird flu in India in 2008 prompted authorities to temporarily ban the sale of poultry.

Diptendu Dutta/AFP/Getty Images

A smoldering debate about whether researchers should ever deliberately create superflu strains and other risky germs in the interest of science has flared once again.

Shots - Health News Scientists Disclose Plans To Make Superflu In Labs

Proponents of the work say that in order to protect the public from the next naturally occurring pandemic, they have to understand what risky infectious agents are capable of — and that means altering the microbes in experiments. Critics argue that the knowledge gained from making new strains of these germs isn't worth the risk, because a lab-made pathogen might escape the laboratory and start spreading among people.

Now, as scientists on both sides of the dispute have formed groups that have issued manifestos and amassed lists of supporters, it looks like the prestigious National Academy of Sciences will step in to weigh the risks and benefits.

“ I don't think we have adequately involved the public so that they understand the possible consequences of mistakes, or errors, or misadventures in performing this kind of science.

A representative of the National Institutes of Health, which funds this research, says that NIH, too, is "giving deep consideration to the many views expressed by various highly respected parties" about the best way forward.

In a recent editorial in "mBio," the journal's editor-in-chief, Dr. Arturo Casadevall, urged his colleagues to "lower the level of rhetoric and focus on the scientific questions at hand."

Scientists have passionate debates all the time, but it's usually about the meaning of some experimental result, says Casadevall, a microbiologist at the Albert Einstein College of Medicine in New York.

"What is different here is that we are facing a set of intangibles," he says. "And because they involve judgment calls at this point, people are often weighing the risks and the benefits very differently."

Dr. David Relman, a microbiologist at Stanford University, thinks the risks of making a new strain of flu virus that has the potential to cause a pandemic are very real.

"I don't think we have adequately involved the public," Relman says, "so that they understand the possible consequences of mistakes, or errors, or misadventures in performing this kind of science — the kinds of consequences that would result in many, many people becoming ill or dying."

“ These viruses are out there. They cause disease; they have killed many, many people in the past. We bring them to the laboratory to work with them.

Controversial work on lab-altered bird flu was halted for more than a year in a voluntary moratorium, after two labs generated new, more contagious forms of the bird flu virus H5N1. Eventually, after federal officials promised more oversight, the experiments started back up and the controversy quieted down. But key questions were never answered, Relman says.

"One of the big issues that has not been advanced over the last two years is a discussion about whether there are experiments that ought not to be undertaken and, if so, what they look like," he says, noting that scientists keep publishing more studies that involve genetically altered flu viruses. "You know, every time that one of these experiments comes up, it just ups the ante a bit. It creates additional levels of risk that force the question: Do we accept all of this?"

Last month, Relman met in Massachusetts with others who are worried. They formed the Cambridge Working Group and issued a statement saying that researchers should curtail any experiments that would lead to new pathogens with pandemic potential, until there's a better assessment of the dangers and benefits.

Shots - Health News Feds Tighten Lab Security After Anthrax, Bird Flu Blunders

By coincidence, they released their official statement just as the public started hearing news reports of various laboratory errors, such as a forgotten vial of smallpox found in an old freezer, and mishaps involving anthrax and bird flu at the Centers for Disease Control and Prevention.

What's more, the unprecedented Ebola outbreak has reminded the public what it looks like when a deadly virus gets out of control.

All of this led a different band of scientists to also form a group — to publicly defend research on dangerous pathogens.

"There are multiple events that have come together in a rather unusual convergence," says Paul Duprex, a microbiologist at Boston University.

He sees the recent reports of lab mistakes as exceptions — they don't mean you should shut down basic science that's essential to protecting public health, he says.

"These viruses are out there. They cause disease; they have killed many, many people in the past," Duprex says. "We bring them to the laboratory to work with them."

Duprex helped form a group that calls itself Scientists for Science. The group's position statement emphasizes that studies on risky germs already are subject to extensive regulations. It says focusing on lab safety is the best defense — not limiting the types of experiments that can be done.

Whenever questions about safety are raised, Duprex says, scientists have one of two options. They can keep their heads down, do their experiments and hope it will all go away. Or, he says, they can proactively engage the public and provide an informed opinion.

His group has taken the latter approach, "because ultimately we're the people working with these things."

Each of these two groups of scientists now has a website, and each website features its own list of more than a hundred supporters, including Nobel Prize winners and other scientific superstars.

One thing that almost everyone seems to agree on is that, to move forward, there needs to be some sort of independent, respected forum for discussing the key issues.

The American Society for Microbiology has called on the prestigious National Academy of Sciences to take the lead. A representative of the Academy says NAS does plan to hold a symposium, later this year. The details are still being worked out.

Tim Donohue, a microbiologist at the University of Wisconsin, Madison who is president of ASM, says a similar kind of debate happened back in the mid-1970s, when brand-new technologies for manipulating DNA forced scientists and the public to tackle thorny questions.

"And I think that is a productive exercise," Donohue says, "to have scientists and the public, sitting around the table, making sure each one understands what the benefits and risks are, and putting in place policies that allow these types of experiments to go on so that they are safe and so that society can benefit from the knowledge and innovation that comes out of that work."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Colorado Case Puts Workplace Drug Policies To The Test

NPR Health Blog - Tue, 08/12/2014 - 4:32pm
Colorado Case Puts Workplace Drug Policies To The Test August 12, 2014 4:32 PM ET Listen to the Story 4 min 6 sec  

Brandon Coats says he legally uses marijuana to relieve pain, but never at work.

Courtesy of Michael Evans

A car accident crushed Brandon Coats' upper spine when he was 16, leaving him unable to walk. His muscles still spasm, disrupting sleep and causing pain.

"If I'm out in public it's embarrassing," Coats says. "It's always uncomfortable. If I smoke marijuana, it almost completely alleviates it" — more, he says, than other prescriptions.

Coats smokes at night, and says he was never high when answering customer calls at Dish Network. "I was really good at my job," he says.

But five years ago, after he was called in by supervisors for a random drug test, he became persona non grata at the company.

"I went to open up the door and my card wouldn't open up the door anymore," Coats says.

It's been 25 years since the federal Drug-Free Workplace Act was passed, creating requirements for federal government workers and contractors. Many companies, including Dish Network, followed suit, and today more than a third of private employers have drug-testing policies.

Although marijuana is now legal in two states and approved for medical use in nearly half, the drug policies of many companies haven't kept pace.

Coats has sued Dish Network over its marijuana policy; his case is now before the Colorado Supreme Court.

"We're not pushing for use at work," says Coats' attorney, Michael Evans. "We're pushing for, if you're in the privacy of your own home, you're registered with the state and abiding by the constitutional amendment, is that an OK reason for your employer to fire you?"

Since Evans sued Dish, Colorado has legalized pot, making it a regulated substance, like alcohol. But, as Evans notes, workplaces still treat pot — and test for its use — in a manner very different from alcohol.

“ If you had a martini on Saturday night, or smoked pot on Saturday night, but you're fine on Monday morning, how is Saturday night the employer's business?

"The test that Dish did was a saliva test," Evans says, "and all the test was concerned about was, 'Is THC present, yes or no?' "

Shots - Health News Medical Marijuana 101: You Can't Smoke That On Campus

And therein lies a problem. The standard urine test most commonly used in employer drug testing measures the presence of THC — a psychoactive compound in marijuana that persists in the body for days, weeks or even longer. So a positive marijuana test doesn't necessarily mean the person taking the test is high, or has even used the drug recently.

Barry Sample is director of science and technology for Quest Diagnostics, which conducts millions of drug tests. He says there may eventually be intoxication tests for pot that are more like the Breathalyzer's detection of recent alcohol use. "It might be possible at some point, but it's still developing," he says.

For now, businesses are neither changing nor relaxing the way they test for pot. In a 2011 survey of major employers by the Society for Human Resource Management, more than half of the companies responding said they conduct drug tests on all job candidates. And that raises some questions for businesses, says the society's Deborah Keary.

"If you had a martini on Saturday night, or smoked pot on Saturday night, but you're fine on Monday morning, how is Saturday night the employer's business?" Keary says. "So I really think they're going to have to change the way they do testing and define impairment."

Your Money Can Bosses Do That? As It Turns Out, Yes They Can

And at least in Colorado, the legalization of pot is putting employers in even murkier legal territory.

Around the Nation Should Getting High Stop You From Getting Hired?

Under state law, employers can prohibit use of marijuana at work. But another state law, the "Lawful Activities" statute, prohibits an employer from discharging an employee for engaging in lawful activity off the premises of the business during nonworking hours.

"That's where everything really gets muddied up," says Lara Makinen, legislative affairs director in Colorado for the Society for Human Resource Management. She says employers are getting a very mixed message.

"We're being told, 'Keep your policy as it is, but proceed with caution, because if people are fired, like Mr. Coats, we probably will see lawsuits,' " Makinen says.

Dish Network, the defendant in the Brandon Coats case, declined to comment. But the company has said it is sticking by its drug-free policy, which it says is consistent with federal law — law that still considers pot an illegal substance.

Oral arguments for Coats' case are set to begin in late September.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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A Life Of Anxiety Documented

NPR Health Blog - Tue, 08/12/2014 - 3:33pm
A Life Of Anxiety Documented August 12, 2014 3:33 PM ET
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    It's Hardly Noticeable XIII

    Keedy's series depicts an anonymous character who suffers from anxiety.

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    It's Hardly Noticeable I

    Most of the photos are based on Keedy's own experiences, and some are based on the experiences of others who suffer from similar disorders.

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    It's Hardly Noticeable XVI

    Keedy flossed 300 times in order to make this image. "Thinking about it still makes my gums hurt," he says.

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    It's Hardly Noticeable XXXVI

    While some of the photos depict the character's actions, others focus on his mental state.

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    It's Hardly Noticeable XV

    Keedy himself modeled for the series.

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    It's Hardly Noticeable VI

    At times, anxiety can be a very isolating experience, Keedy says.

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    It's Hardly Noticeable XXXI

    "For some this is comforting space, and for other's it's not somewhere they'd want to be," Keedy says.

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When photographer John William Keedy was first diagnosed with an anxiety disorder, he says he had a hard time coping. It was difficult to accept. It was difficult to explain to friends and family. He felt utterly alone.

"I hate to say it, but I was embarrassed by it," he tells Shots.

Years later, Keedy, 29, started shooting a series of photographs about his condition. The images are deeply personal, and striking. In person, they're more than 3 feet long and 2 feet wide.

Now, he says, he wants to show them off, "if only to help a couple of people who are going through the same thing in some way feel that they're not alone in this."

We asked Keedy, who now lives in San Antonio, about his creative process and the challenges of portraying mental illness. The conversation has been edited for length and clarity.

Where did the title of the series — "It's Hardly Noticeable" — come from?

The title actually came from something I wrote in one of my journals. At the time I was so convinced I was doing such a great job of concealing my anxiety, when really I wasn't.

So it's ironic, a little tongue-in-cheek. The images themselves are so theatrical, and over the top and not by any means subtle. But it's like, 'Don't worry, it's hardly noticeable.'

It's Hardly Noticeable VIII

John Keedy

Your photos depict an anonymous character, modeled by you. To what extent do you identify with him?

I would love to say, 'Oh, that's totally somebody I just invented.' And it's really not. But it's easier for me to talk about it in terms of the character, so I keep calling him the character.

I'm sort of protective of him, and I worry that people will get the wrong idea about him. Because my concern is that if people view just the images without the figure and look at the actions, their minds will conjure up this image of this crazy-haired, wild-eyed person. And that's not who the vast majority of people facing these challenges are.

He's just an average person, just a normal man. He's just like anybody.

When did you start shooting the photographs?

It took seven or eight years after I was diagnosed with an anxiety disorder before I started making these images. And to be completely honest, this started as a way for me to indulge my own anxieties and my own compulsions, but still stay productive in a way.

A lot of the images portray these repeated actions, and I actually performed the actions. So there's the image with the floss in the sink. I flossed with 300 of these flossers. Thinking about it still makes my gums hurt.

But to be honest, for the most part it wasn't completely unpleasant. There's some comfort in the repetition for me. So the project sort of allowed me to indulge in this sort of thinking for a set period of time, and when I was done with a photo, it was fine to get it back under control.

The floss one hurt a lot, though.

At what point did you decide to show them to the public?

It wasn't originally something that I planned on showing to a lot of people. I was worried about what people were going to think about me and about my mental state.

But after showing them to a few people with mental disorders, and hearing them say that they identified with them, I thought it was important to make an effort to show them more.

There's a stigma that goes with having a mental illness. It comes with this idea of weakness of will. Which is weird, because if somebody had a broken arm you'd never tell them to will their way out of it.

It's Hardly Noticeable XX

John Keedy

And because it's not something that a lot of people talk about, it's easy to feel that you're alone, that you're the only one who's having these thoughts and feeling these feelings.

Was it hard to explain what anxiety feels like?

The idea of mental illness for those that haven't experienced it firsthand is that it's something purely psychological. But for me, a lot of it was physical. Trying to put that into words and describe what it felt like was difficult.

The photograph that's the most personal and that makes me the most nervous is the one with the doorbell with the thumbtacks on it. When my anxiety was at its worst, I had this really conflicted relationship with other people.

I really wanted to be in contact with my friends and my family, but there was something physically just keeping me back from it. A friend would call, and I'd just stare at the phone. I'd really want to answer it, and I felt I couldn't. There was something keeping me from doing that.

It's Hardly Noticeable XXXII

John Keedy

So the doorbell image really sums up that feeling. You know, the doorbells work, and the lights are on inside. But in order to use them, you have to go though this really physical pain.

Your photos are really arresting, but some of them also have an element of humor. The photo of the leaking glass of milk, for example. It's like your character is trying to stay positive, to see the glass as being half-full but it's just not working out.

It's also a wink and a nudge to Sisyphus: You're constantly working to make sure the glass stays full. And to the idea of 'crying over spilled milk.'

I have a hard time taking myself too seriously. And when I was dealing with this at its worst, a lot of the way I coped with it was through humor. If I joked about it, then it wasn't that bad.

Mental illness is a very serious, intense subject. And it's already something that people don't like encountering and discussing. So I use humor to sort of make my photos a little bit more accessible.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Can Divorced Dad Be Forced To Cover Insurance For Adult Kids?

NPR Health Blog - Tue, 08/12/2014 - 9:53am
Can Divorced Dad Be Forced To Cover Insurance For Adult Kids? August 12, 2014 9:53 AM ET

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When it comes to health insurance for young adults, the Affordable Care Act made it possible for kids to stay on their parents' health plans until they turn 26. It was one of the first provisions of the law to take effect and has proved popular. But what happens when the parents are divorced? Here's a look at that question and a couple of others about coverage issues.

My ex-husband has been responsible for providing health insurance for our kids until the age of majority. My sons are now 21 and almost 18. My ex has family coverage for himself and his new wife, but he wants me to put the kids on my insurance now that they have reached the age of majority. Covering the kids doesn't cost him anything extra, but for me to switch from a single plan to a family plan is an extra $175 a month and I can't afford it. Since the age of majority for health insurance is now 26, is it possible he still is required to keep them on his insurance?

No, he's not obligated to keep them on his health plan. Under the health law, insurers must offer to cover young adults up to age 26, but parents aren't obligated to provide it, says Timothy Jost, a law professor at Washington and Lee University and an expert on the health law.

Further, the requirement to offer coverage isn't related to the age of majority, which is defined by individual states and is generally between 18 and 21, says Randy Kessler, an Atlanta divorce lawyer and past chair of the American Bar Association's family law section.

The health insurance coverage arrangement that you describe is pretty typical, says Kessler. You could go back to court and try to get your child-support payments increased to cover the cost of providing health insurance for the kids, but "it would be unusual for the courts to be helpful," says Kessler. Absent some significant change in your or your ex-husband's finances, or unforeseen and costly medical expenses for your children, in general "you can't have another bite at the apple."

With no legal requirement to compel either of you to cover your kids, it's something the two of you will just have to work out, says Kessler. In addition to covering your children on your own plan or your ex's plan, it's also worth exploring whether they might qualify for subsidized coverage on the state marketplaces or for Medicaid, if your state has expanded coverage to childless adults. If they're in college, student health coverage is worth investigating as well.

My husband was recently in the hospital for a pacemaker implant. He was set to come home but developed a staph infection and a blood clot. He now has to receive an antibiotic infusion for six to eight weeks. Medicare would not pay for home infusion, so he has to travel 30 minutes to the infusion center every day. Is there anything we can do?

Probably not. Infusion therapy means administering drugs intravenously, and although it can be done in settings such as outpatient centers, hospitals or nursing homes, many patients would prefer to receive their drugs at home. But even though most private health plans and some Medicare Advantage managed care plans pay for home infusion, the traditional Medicare fee-for-service program generally doesn't. There's an exception for roughly 30 drugs that must be administered using an IV infusion pump. These are covered under Medicare Part B's durable medical equipment benefit. But Medicare generally won't pick up the tab to intravenously administer other drugs such as antibiotics at home, even though the drugs themselves may be covered under Part D, Medicare's prescription drug benefit.

"It's a basic flaw," says Russ Bodoff, president and CEO of the National Home Infusion Association, a trade group for home infusion providers. "Every site of care is covered except the home." Bodoff's organization is working on legislation that would expand Medicare's coverage of home infusion therapy.

For now, though, if you want your husband to receive his antibiotic IV therapy at home, you may have to pay for the cost of the equipment, supplies and any nursing services on your own.

My wife will be exploring insurance options on the federal exchange in November. In regard to subsidies, we file jointly and most of our income comes from dividends derived from jointly owned assets. I am assuming that her share of that income would be precisely half of the annual total income (in addition to her earned income from part-time work.) Is this a fair assumption?

No, it's not. Premium tax credits are available on the health insurance marketplace to people with incomes between 100 and 400 percent of the federal poverty level (in November that will be $15,730 to $62,920 for a couple). Eligibility is based on household income, not her income alone. If the modified adjusted gross income (MAGI) for the two of you falls within those limits, she could be eligible for a subsidy. Under the health law, MAGI would include your wife's wages and your dividend income, as well as tax-exempt Social Security benefits, tax-exempt interest and tax-exempt foreign income, says Mark Luscombe, a federal tax analyst at Wolters Kluwer, CCH, a provider of tax and accounting information to professionals.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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A Coping Plan Can Help Fend Off Depression From Vision Loss

NPR Health Blog - Mon, 08/11/2014 - 3:28am
A Coping Plan Can Help Fend Off Depression From Vision Loss August 11, 2014 3:28 AM ET Listen to the Story 3 min 20 sec  

One of the scariest parts of advanced macular degeneration can be losing the ability to read facial expressions.

Maria Pavlova /iStockphoto

When people lose their vision as they get older, they lose a lot of other things, too. They lose their ability to do the things they love.

"You can't read, you can't cook, and you can't socialize — and as a result, you may become demoralized, withdrawn and depressed," says Dr. Barry Rovner, a geriatric psychiatrist at Thomas Jefferson University in Philadelphia.

Rovner is not talking about typical eyesight deterioration as we age. He's talking about a specific condition called age-related macular degeneration, which, in severe cases, afflicts about 2 million older Americans. The macula is the central part of the retina that contains the densest concentration of light-sensing receptors, and it's crucial for making out fine details. Perhaps the scariest part of the loss is that people often can't recognize faces or "read" someone's facial expression.

Shots - Health News Cheap Drug Beats Pricey One In Treating Vision Loss In Elderly

"If you can't see somebody's face, you feel disengaged and frightened," Rovner says. "The consequence is you may withdraw; many people withdraw."

In fact, research suggests about 25 percent of people with macular degeneration in both eyes go on to develop clinical depression. So Rovner decided to test a style of psychological therapy called behavior activation. This treatment helps give patients strategies to build on whatever functional vision they have so they can continue their day-to-day activities and carry on an active social life. Rovner wanted to see if the approach would help people with macular degeneration ward off depression.

He recruited 188 people, mostly women in their early to mid-80s, who had age-related macular degeneration in both eyes and mild depressive symptoms. Each was considered at risk for more severe, clinical depression. Everyone in the study had a therapist come to their house six different times in two months. In half the cases the therapists simply talked to patients for an hour about their vision loss and disability. In the other half, the therapists used the hour to help the patient develop a strategy for coping with the lost vision.

“ My world was stopping. I couldn't do anything anymore.

Marilyn Freedman took part in the study. She's 84 years old and lives in Cherry Hill, New Jersey. Freedman developed macular degeneration in both eyes and, as the condition worsened, she was starting to get depressed.

Many of the things she loved — reading, watching television, driving — were becoming difficult, she says. "My world was stopping. I couldn't do anything anymore."

But the most depressing thing for Freedman was to no longer be able to cook or bake for her big family.

"If I can't read a recipe, I can't bake," she says. "That stopped me right there. I didn't do any more baking."

Freedman was put in the group that was given behavior activation therapy. For Freedman, that meant writing giant-sized recipes with one ingredient on every page.

"One page had a cup of sugar, the next page will be a spoonful of salt, the next page would be three eggs," she says.

It was a simple plan, but it soon got Freedman back in the kitchen. Now she says she's cooking entire dinners again for her family.

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Each person in the study got different strategies. Some people wanted to get out and socialize again, so their plan included calling a friend at regular set times to schedule an outing. Book lovers were encouraged to update the 30-year-old lighting in their homes and invest in a variety of different magnifiers that enabled them to keep reading. Patients who could no longer recognize faces were encouraged to admit the vision loss to their friends instead of withdrawing out of fear of making a mistake or seeming rude.

The results were dramatic: Patients in the study who created a plan and stuck to it cut their risk of depression by more than half, Rovner says, compared to those who received only the talk therapy.

Vision is the primary way sighted people engage in the world, he says. If you can help someone who is losing their sight come up with coping strategies, there's a good chance you'll keep them engaged — and keep depression at bad.

"People tend to ruminate on what they've lost," says Rovner. "That's why we say, 'Do the plan. Follow the plan, not your feelings.' "

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Where We Learn That Artificial Eyes Really Aren't Round At All

NPR Health Blog - Mon, 08/11/2014 - 3:27am
Where We Learn That Artificial Eyes Really Aren't Round At All August 11, 2014 3:27 AM ET Listen to the Story 5 min 2 sec  

A prosthetic eye is a work of art custom-crafted for an individual.

Rebecca Davis/NPR

Almost every time reporters go out on assignment, they run across something unexpected that they just can't fit into the story they're working on.

When science correspondent Joe Palca and producer Rebecca Davis were in Boston reporting on a boy with a rare form of cancer, they found themselves in the office of Jahrling Ocular Prosthetics, a business dedicated to making artificial eyes.

Joe and Rebecca spoke with Joyce and Eric Jahrling, two of the four Jahrlings who work at this family firm, and learned some surprising things about making prosthetic eyes — and what it's like to wear them.

What follows is an edited version of their adventure.

================================

Rebecca Davis: Joe gets squeamish when he has to talk about eyes — he says it's something to do with eye surgery he had when he was a small child. So I'm going to jump in when things get what Joe calls "icky."

Joe Palca: And I promise I won't get too icky because I can't handle it. Anyway, we were in Boston to tell the story of a young boy named Noah Shaw. He was born with a rare eye cancer called retinoblastoma, and as part of his treatment he had to have an eye removed.

Noah has needed new prosthetic eyes as he has grown. His remaining eye has changed color from blue to a blue-green.

Courtesy of the Shaw family

Well, that surgery was five years ago. Noah is now a healthy 6-year-old, and wearing a false eye is normal for him — no big deal. But because he's still growing, he has to get a new eye made from time to time.

Rebecca: So we got to go with Noah and his parents, Bryan and Elizabeth Shaw, for the fitting. And the thing that surprised both of us was about the shape of that artificial eye.

Joe: Yeah, I thought that a fake eye would be round!

Joyce Jahrling: That's only in the movies when it rolls down the planks.

Joe: These fake eyes are actually small curved bits of plastic — kind of like a contact lens — and they're slipped under the eyelids of the missing eye. That's how they're held in place.

Rebecca: And watching the Jahrlings make these prosthetics, as they are officially known, is really like watching an artist at work.

Eric Jahrling adds tiny red threads to a prosthetic eye to represent blood vessels.

Rebecca Davis/NPR

Eric Jahrling: I'm making my own acrylic paints. This is a raw plastic.

Rebecca: He's using a fine brush to paint what looks like a near perfect replica of Noah's existing eye.

Joe: When he's done at the workbench he calls Noah over.

Eric: OK, let's take a look at your face, mister. I think you need a little bit more gold in there.

Joe: Eric takes the eye back to his workbench. He's got a bit more painting to do; he wants to make the pupil a little bigger, he wants to add some tiny red threads to that will look like blood vessels.

Rebecca: At an earlier appointment, Eric's sister Joyce took a mold of Noah's actual socket, where his eye used to be.

Joyce: I usually do the impression of the eye socket, like they take impressions of your mouth. Same gel. No flavor. But you don't gag.

Joe: So Eric is done touching up the eye, and Joyce comes over to see how it looks on Noah.

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Joyce: How's that feel?

Noah: Good.

Joyce: Let me see. Let me see. Chin way up there. Not bad!

Rebecca: Joe, I was really surprised that you asked Joyce how to take the eye back out again.

Joe: Yes, I was pretty proud of myself.

Joyce: You can use your fingers to take it out. You have a suction cup. Or we even say the third method is the wooden mallet to the back of the head.

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Rebecca: We heard a lot of that kind of dark humor when doing this story, especially from Noah's parents!

Joe: Oh that's so true: Noah's parents have these amazing stories about things that happen when your child has a fake eye.

Bryan Shaw: So one of the most common things when we got the first eye is sometimes it would rotate 100 degrees, and so the pupil would be looking like it was staring down below the lid further than you could normally even move your eye, and it would just look creepy. It would look way creepier than if the eye was even gone.

Rebecca: Bryan calls that the 'zombie rotation'. And they also told us that Noah got really good at taking his eye out.

Bryan: He would always take it out when he first got it and chew on it.

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Rebecca: And he used to play this little game with his mom and dad. They'd put him down for bed, then they'd leave the room. And a few minutes later, Noah would take his eye out and throw it on the ground. It sounded like an M&M hitting the hardwood floor. And then of course, Mom and Dad would go rushing back into the room, which would make Noah terribly happy.

Joe: And then there was the time that Noah took his eye out when they were on a city bus.

Elizabeth Shaw: I didn't realize it until after I got off the bus and looked at him, and I was like, 'Oh my gosh, your eye is gone!'

Bryan: She put an ad on Craigslist. It said 'Lost: Prosthetic Eye.' And then she put in parentheses 'It's not a sphere,' and she held up a picture like the old one.

Elizabeth: I had a picture of what it looked like, and finally I called the MBTA mass transit and I said, 'I think my son's eye might be on your bus.'

Joe: A few days later the mass transit folks knocked on Elizabeth's door and said 'Excuse me, ma'am, is this yours?'

Elizabeth, Samuel, Bryan and Noah Shaw amid Texas bluebonnets on Easter Sunday. Samuel was conceived with in vitro fertilization so he would not suffer from the hereditary cancer that afflicted Noah.

Courtesy of Elizabeth Shaw Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Recovery Coach Helps An Addict Resist Heroin's Lure

NPR Health Blog - Sun, 08/10/2014 - 3:06pm
Recovery Coach Helps An Addict Resist Heroin's Lure August 10, 2014 3:06 PM ET

fromWBUR

Listen to the Story 4 min 26 sec  

Among heroin addicts who are able to quit, 40 to 60 percent relapse within the first year — many within the first weeks of release from a treatment program.

Diane Diederich/iStockphoto

The first time Jeremy Wurzburg left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. But one week later, the skinny, pale young man was hanging out with a guy who was also in early recovery, experiencing what Wurzburg, now 21, has come to realize is a typical turning point for recovering addicts: two guys sitting casually in a car, poised to use drugs again.

"We're not sure whether we're going to use or not," he says, "and someone makes like a half joke – 'We could just go out and drink right now,' or something. And the other one is like, 'Yeah let's do that. Sounds good.' "

From that first drink, Wurzburg was quickly back to heroin, his drug of choice. Most recovery programs don't — and maybe can't — prepare freshly discharged patients to fight that urge on their own, he says.

High Relapse Rate In First Year Of Recovery

"Once I got out of treatment into the real world, it was a big shock," Wurzburg says.

Of patients addicted to heroin who are able to quit their habit, 40 to 60 percent relapse within the first year — often within the first weeks of finishing a treatment program, studies show.

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Wurzburg is now in a new program aimed at young adults. It's a one-year pilot project run by Gosnold, a network of addiction treatment services on Cape Cod.

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As part of the program, Wurzburg agreed to live in a household that doesn't allow the use of drugs or alcohol. He agreed to attend daily 12-step group meetings and to get individual counseling. Perhaps most importantly, Wurzburg now has help daily — sometimes hourly — from a recovery coach.

Coaches in the Gosnold program get much more involved in the lives of the people they're mentoring than the typical sponsor in a Narcotics Anonymous program would.

The recovery coaches show patients "how to manage their emotions," says Wurzburg's coach, Kristoph Pydynkowski — "how to fill out job applications, how to go to meetings, how to take care of themselves, how to go back to school." Pydynkowski, who also calls himself a "cheerleader, a beacon of hope," quit using heroin seven years ago.

Much More Than A Sponsor

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Pydynkowski ticks off the list of things he and Wurzburg now do together: visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother, fishing and 6:15 a.m. trips to a coffee shop before attending NA meetings. Pydynkowski helps each of the 10 patients he manages create and follow a weekly recovery treatment plan.

Ray Tamasi, the director at Gosnold, says this aggressively supportive approach is paying off. His evidence? A comparison of medical records collected during the year before the program's inception to records collected in the year after its start. The comparison is striking. Fifty-four young adults (ages 18 to 28) who participated in the coaching program saw an 83 percent reduction in admissions to rehabilitation facilities during their year of intensive coaching. Emergency room admissions also dropped — from 16 in the year before the program, down to one during the year of coaching.

Coaching Costs Save States Money

Because fewer people had to be readmitted to rehab centers, Tamasi says, the program saved the state an estimated 37 percent in total outlay.

"Think about the cost/benefit," he says, "if at 19, you're cycling in and out of treatment, but there's an alternative — going back to school and living life."

The program makes sense economically, he says, "and it makes sense simply from the value we place on the human life."

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And it may make more sense to state legislators than simply increasing the number of beds in recovery facilities, he says, "because you can't just keep people in beds all the time. They have to come out at some point."

Gov. Deval Patrick's administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. A task force report recommended more peer support and home-based counseling. Health insurers and state Medicaid leaders have said they will look into funding for recovery coaches, but there is right now no plan in place.

New York and Tennessee pay for peer coaches to help treat addiction through Medicaid — something Massachusetts is taking a look at. The use of coaches is built on the idea that addiction is a disease that patients will deal for life, a disease that will be treated by primary doctors in a general medical setting, not just in rehabilitation facilities.

Pydynkowski is teaching his patients to treat addiction as they would hypertension or diabetes.

It's just like taking insulin, he says, "watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill — making sure I'm taking care of myself."

This story is part of a reporting partnership among NPR, WBUR and Kaiser Health News.

Copyright 2014 WBUR. To see more, visit http://www.wbur.org.
Categories: NPR Blogs

Advice For Dating With Asperger's: Don't Call 100 Times A Week

NPR Health Blog - Sat, 08/09/2014 - 4:54am
Advice For Dating With Asperger's: Don't Call 100 Times A Week August 09, 2014 4:54 AM ET

You think it's romantic. She thinks it's creepy.

Katherine Streeter for NPR

Dating isn't easy, and it's even less so when you've got Asperger's, an autism spectrum disorder that can make it hard to read social cues.

Jesse Saperstein knows that all too well. In his new book, "Getting a Life with Asperger's: Lessons Learned on the Bumpy Road to Adulthood," the 32-year-old tells his fellows on the spectrum that they need to be up front with potential dates that they have Asperger's. And he says they also need to realize that what feels to them like sincere interest can all too often be perceived as creepiness. This is an edited version of our conversation.

You say that some of the traits common in people with Asperger's can make social life especially challenging. Why is that?

I believe my peers and I, we achieve great things by being unrelenting. We don't know when to stop. We can go after things for years. But that relentlessness does not work with humans and human emotions. In adulthood, that translates to full-blown stalking. Sometimes there are legal consequences that could be avoided when the intent is harmless.

Have you been accused of stalking?

You have no idea. I have definitely been accused of that many times. In college I would try to win people over by giving them long hand-written cards. I continued this into adulthood, but it wasn't considered cute. It was considered disturbing.

What did you do to fix that?

Now I tell you, 'I have Asperger's and this is how I communicate. If this bothers you, you just need to tell me so I'll do better in the future.' Ninety-nine percent of the time that works. I sure don't want to miss the people who would love a hand-written card.

The purpose of my book is to help people shave off experiences that cause damage. So they'll know from my experiences that if you call someone 100 times in a week, it may work in the movies but it most likely leads to disaster in reality.

You said online dating was tough to figure out. How so?

It was hard for someone who is not able to let go easily. Online dating is all about letting go, and a lot of hidden signals. You can let go and definitely not get what you want but avoid a lot of consequences.

What kind of consequences?

One of the golden rules is not to invest a lot of money the first or second time you meet someone. I used to think that if I spent a lot of money on a Broadway show or a four-star restaurant it might not make a woman fall in love with me, but it sure would help. That is erroneous.

I think that is one of the things that contributed to my $25,000 credit card debt.

I kind of did it to myself, but at the time it did seem like a really good idea.

How do you deal with rejection?

With dating it does not matter how cruel or sudden the rejection is, when someone demands to be let alone you have to respect that. I'll tell people, contact this person only once a year and see what happens. That may not be appropriate, but it's a lot better than being relentless.

Are you dating someone now?

I'm seeing a woman right now who's a few year younger than me. It's hard due to our very hectic schedules; she's still going to school. What helps is her bringing issues to my attention instead of sitting on them, so I can work through them.

What's the message you want people to remember from your book?

Success with autism or any kind of challenge comes from knowing you have incredible things to offer. Mistakes don't mean you're a loser.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Advice For Dating With Asperger's: Don't Call 100 Times A Week

NPR Health Blog - Sat, 08/09/2014 - 4:54am
Advice For Dating With Asperger's: Don't Call 100 Times A Week August 09, 2014 4:54 AM ET

You think it's romantic. She thinks it's creepy.

Katherine Streeter for NPR

Dating isn't easy, and it's even less so when you've got Asperger's, an autism spectrum disorder that can make it hard to read social cues.

Jesse Saperstein knows that all too well. In his new book, "Getting a Life with Asperger's: Lessons Learned on the Bumpy Road to Adulthood," the 32-year-old tells his fellows on the spectrum that they need to be up front with potential dates that they have Asperger's. And he says they also need to realize that what feels to them like sincere interest can all too often be perceived as creepiness. This is an edited version of our conversation.

You say that some of the traits common in people with Asperger's can make social life especially challenging. Why is that?

I believe my peers and I, we achieve great things by being unrelenting. We don't know when to stop. We can go after things for years. But that relentlessness does not work with humans and human emotions. In adulthood, that translates to full-blown stalking. Sometimes there are legal consequences that could be avoided when the intent is harmless.

Have you been accused of stalking?

You have no idea. I have definitely been accused of that many times. In college I would try to win people over by giving them long hand-written cards. I continued this into adulthood, but it wasn't considered cute. It was considered disturbing.

What did you do to fix that?

Now I tell you, 'I have Asperger's and this is how I communicate. If this bothers you, you just need to tell me so I'll do better in the future.' Ninety-nine percent of the time that works. I sure don't want to miss the people who would love a hand-written card.

The purpose of my book is to help people shave off experiences that cause damage. So they'll know from my experiences that if you call someone 100 times in a week, it may work in the movies but it most likely leads to disaster in reality.

You said online dating was tough to figure out. How so?

It was hard for someone who is not able to let go easily. Online dating is all about letting go, and a lot of hidden signals. You can let go and definitely not get what you want but avoid a lot of consequences.

What kind of consequences?

One of the golden rules is not to invest a lot of money the first or second time you meet someone. I used to think that if I spent a lot of money on a Broadway show or a four-star restaurant it might not make a woman fall in love with me, but it sure would help. That is erroneous.

I think that is one of the things that contributed to my $25,000 credit card debt.

I kind of did it to myself, but at the time it did seem like a really good idea.

How do you deal with rejection?

With dating it does not matter how cruel or sudden the rejection is, when someone demands to be let alone you have to respect that. I'll tell people, contact this person only once a year and see what happens. That may not be appropriate, but it's a lot better than being relentless.

Are you dating someone now?

I'm seeing a woman right now who's a few year younger than me. It's hard due to our very hectic schedules; she's still going to school. What helps is her bringing issues to my attention instead of sitting on them, so I can work through them.

What's the message you want people to remember from your book?

Success with autism or any kind of challenge comes from knowing you have incredible things to offer. Mistakes don't mean you're a loser.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs
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